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General NPI Number Information
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NPI Number | 1982809935
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Entity Type | Organization
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Legal Business Name | SULLIVAN COUNTY REGIONAL
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 154 BLOUNTVILLE BYPASS
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City | BLOUNTVILLE
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State | TN
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Zip | 37663
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Country | US
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Telephone | 423-279-2783
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Fax |
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Provider Business Mailing Address
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Address Line | 915 HIDDEN VALLEY RD
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City | KINGSPORT
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State | TN
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Zip | 37663-3413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TENNDERCARE OUTREACH SPECIALIST
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Name | MICHELE SHELTON
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Credential |
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Telephone | 423-677-6766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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